scholarly journals Rapid drinking challenge during high-resolution manometry is complementary to timed barium esophagogram for diagnosis and follow-up of achalasia

2018 ◽  
Vol 30 (11) ◽  
pp. e13404 ◽  
Author(s):  
F. A. Ponds ◽  
J. M. Oors ◽  
A. J. P. M. Smout ◽  
A. J. Bredenoord
Keyword(s):  
High Resolution ◽  
High Resolution Manometry ◽  
Barium Esophagogram ◽  
Timed Barium Esophagogram

scholarly journals Two-Person Technique of Peroral Endoscopic Myotomy for Achalasia with an Advanced Endoscopist and a Thoracic Surgeon: Initial Experience

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Madhusudhan R. Sanaka ◽  
Ramprasad Jegadeesan ◽  
Prashanthi N. Thota ◽  
Udayakumar Navaneethan ◽  
Rocio Lopez ◽  
...  
Keyword(s):  
Peroral Endoscopic Myotomy ◽  
Column Height ◽  
Therapeutic Success ◽  
Delayed Bleeding ◽  
Eckardt Score ◽  
Thoracic Surgeon ◽  
Endoscopic Myotomy ◽  
Barium Esophagogram ◽  
Timed Barium Esophagogram

Background and Aims. We initiated peroral endoscopic myotomy (POEM) utilizing a two-person technique with combination of an advanced endoscopist and a thoracic surgeon with complementary skills. Our aim was to determine the feasibility and outcomes in initial 20 patients. Methods. In this observational study, main outcomes measured were therapeutic success in relieving symptoms (Eckardt score < 3), decrease in lower esophageal sphincter (LES) pressures, improvement in emptying on timed barium esophagogram (TBE), and complications.Results. POEM was successful in all 20 patients with a mean operative time of140.1+32.9minutes. Eckardt symptom scores decreased significantly at two-month follow-up (6.4+2.9versus0.25+0.45,p<0.001). Both basal and residual LES pressures decreased significantly (28.2+14.1 mmHg versus12.8+6.3and22.4+11.3versus6.3+3.4 mmHg,p=0.025and <0.001, resp.). Barium column height at 5 minutes on TBE reduced from6.8+4.9 cm to2.3+2.9 cm (p=0.05). Two patients (10%) had mucosal perforations and one had delayed bleeding (5%).Conclusions.Two-person technique of POEM with combination of an advanced endoscopist and a thoracic surgeon is highly successful with low risk of complications.

339 OPTIMAL CUTOFF VALUE OF INTEGRATED LOWER ESOPHAGEAL SPHINCTER RELAXATION PRESSURE FOR ACHALASIA USING STARLET HIGH-RESOLUTION MANOMETRY SYSTEM

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
T Masuda ◽  
F Yano ◽  
N Omura ◽  
K Tsuboi ◽  
M Hoshino ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Type I ◽  
Upper Endoscopy ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
High Resolution Manometry ◽  
Upper Limit ◽  
Esophageal Sphincter ◽  
Barium Esophagogram ◽  
Timed Barium Esophagogram

Abstract   The Starlet high-resolution manometry (HRM) system is currently used in Japan. HRM provides integrated relaxation pressure (IRP) of which value represents adequacy of lower esophageal sphincter (LES) relaxation. The upper limit of normal IRP for the Starlet was proposed as 26 mmHg using healthy subjects. However, few studies have addressed whether this cutoff may well-distinguish patients diagnosed with/without achalasia. We propose the optimal cutoff of IRP for detecting achalasia using the Starlet. Methods Patients who underwent HRM test using the Starlet system at our institution between July 2018 and December 2019 were included. Of these, we excluded patients who had a history of achalasia surgery and/or endoscopic intervention, or whose HRM testing of poor quality. Achalasia was diagnosed if impaired esophageal emptying was evident based on timed barium esophagogram, upper endoscopy, and/or computed tomography. The optimal cutoff value of IRP was estimated using the receiver operating characteristic curve analysis. We further investigate difference in IRP values between achalasia subtypes to identify characteristics of patients who are more likely to be misdiagnosed. Results In total, 145 patients met study criteria. The mean age in our cohort was 52.5 ± 15.5 years, 89 patients (61.4%) were men. Of these, 42 patients (29.0%) were diagnosed with achalasia. In achalasia patients, IRP values extended to a wide-range from minimal 18.7 to maximal 63.9 mmHg. The optimal cutoff value of IRP was 24.7 mmHg with sensitivity 90.5% and specificity 90.3% (AUC 0.96 [95% CI; 0.92¬ to 0.99]). Patients with achalasia type I based on Chicago classification were most likely to have IRP value below the threshold of 25 mmHg (4/19 patients [21.1%]). Conclusion The optimal cutoff value of IRP to distinguish achalasia was ≥25 mmHg using the Starlet HRM system. This value was nearly close to the upper limit of normal IRP value of 26 mmHg in healthy volunteers. Achalasia type I was more likely to have normal IRP value indicating that comprehensive foregut assessment (eg, timed barium esophagogram, upper endoscopy, and computed tomography) is still valuable for management of achalasia.

Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry

2015 ◽  
Vol 28 (1) ◽  
pp. 116-126 ◽  
Author(s):  
M.-T. Pérez-Fernández ◽  
C. Santander ◽  
A. Marinero ◽  
D. Burgos-Santamaría ◽  
C. Chavarría-Herbozo
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
Outflow Obstruction ◽  
High Resolution Manometry

scholarly journals High Resolution Manometry Guidance During Laparoscopic Fundoplication in Pediatric Surgically “Fragile” Patients: Preliminary Report

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 215
Author(s):  
Anna Maria Caruso ◽  
Mario Milazzo ◽  
Vincenzo Tulone ◽  
Carlo Acierno ◽  
Vincenza Girgenti ◽  
...  
Keyword(s):  
High Resolution ◽  
Laparoscopic Fundoplication ◽  
Neurological Impairment ◽  
Esophageal Pressure ◽  
Intraluminal Pressure ◽  
High Resolution Manometry ◽  
Sliding Hernia ◽  
Pressure Changes ◽  
Peak Pressures

Background: High resolution manometry (HRM), has been recently introduced in clinical practice to detect esophageal intraluminal pressure and esophageal motor function. We evaluated the feasibility and usefulness of intraoperative esophageal HRM during antireflux laparoscopic procedures in pediatric cases with neurological impairment (NI) or esophageal atresia (EA). Methods: From January to November 2019, seven children (5 NI, 2 EA) with gastroesophageal reflux (GER) were enrolled. Data on intraoperative pressure changes of the esophagogastric junction (EGJ) and postoperative follow-up data were collected. Results: Average preoperative LES pressures were not significantly different from postoperative pressures. A sliding hernia was detected in all patients as evidenced by EGJ double peak pressures. Hernia correction after esophageal traction was complete in 71.4% of the patients, and residual hernia (<2 cm) was detected in 28.6%. Postoperative EGJ pressures were higher compared to preoperative sphincteric pressures (p < 0.001); in NI patients, higher postoperative values were noted compared to EA (p = 0.05). No sliding hernia and/or GER relapses were recorded. Two patients reported dysphagia postoperatively. Conclusions: Intraoperative HRM may optimize esophageal pressure changes during laparoscopic fundoplication. Further studies are needed to confirm the usefulness of a tailored surgical approach to reduce postoperative complications.

Tu1968 The Rapid Drinking Test During High-Resolution Manometry Has Additional Value in the Diagnosis and Follow-Up of Achalasia

2014 ◽  
Vol 146 (5) ◽  
pp. S-884
Author(s):  
Fraukje A. Ponds ◽  
André J. Smout ◽  
Jac. Oors ◽  
Albert J. Bredenoord
Keyword(s):  
High Resolution ◽  
High Resolution Manometry ◽  
Drinking Test ◽  
Additional Value
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